| NPI | 1518368646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801103635) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 09925153) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2019-02-06 |